A file photo of a dentist at work. Destiny Deffo/Wikimedia
The Dene Nation says the federal and territorial governments are neglecting to provide dental care for NWT Indigenous communities – but the GNWT says it isn’t that simple.
“I am concerned that lack of dental care will further undermine people’s overall health in our communities,” said Dene National Chief Gerald Antoine, alleging some communities have not had local dental care in more than three years, stretching back prior to the Covid-19 pandemic.
The NWT government provided Cabin Radio with a list of dental visits by community that suggests the majority of the territory’s communities have received a dental visit within the past year.
Five communities – Wekweètì, Whatì, Wrigley, Jean Marie River and Nahanni Butte – have not had a dental visit since before the pandemic, but the territory said it had tried to schedule clinics. Dates for those communities’ last dental visits range from May 2019 to February 2020.
In Wekweètì and Whatì, visits last spring were cancelled by the contracted dental provider due to lack of available dentists to send, the territorial government stated.
In the other three communities, a dental contract was offered but “there were no interested parties willing to travel to the communities because of a lack of available dentists,” said the GNWT.
Communities near to a larger centre with a dentist aren’t included. For example, Dettah and Ndılǫ residents are expected to visit a Yellowknife dentist, while people in Enterprise or Kakisa are expected to access services in Hay River.
How are things supposed to work?
Dental services are usually covered in several ways: by employer or private health insurance, or by government programs. Those include the Non-Insured Health Benefits (NIHB) program, which provides service to First Nations and Inuit; Métis Health Benefits; and Extended Health Benefits.
While Canada pays for the NIHB program for some people in Dene communities, the GNWT is responsible for administering the program – hiring dental clinics to visit those communities or helping residents to get appointments if there are no upcoming visits.
For non-urgent care, the GNWT stated, residents “should call the nearest dental clinic to request an appointment and let the clinic know if they require travel assistance to attend the appointment.”
The dental clinic then requests travel approval from NIHB.
If a client has an urgent dental issue, they may be assessed at their local health centre and then referred to NIHB for approval. Once approved, the NWT’s medical travel staff coordinate their trip to a larger centre for dental care – typically within two to four weeks.
However, people typically have to wait six months for a non-urgent appointment.
Describing a lengthy wait to have her children treated by a dentist, one Inuvik resident told Cabin Radio last month: “It didn’t have to come to this. You’re watching your kids in pain and there’s nothing you can do about it.”
GNWT also has concerns
“Governments say they are serving Dene people, but the reality is no service until things are so bad you need emergency care, maybe lose your teeth,” said Chief Antoine in a Dene Nation news release.
“Right now, we don’t even get the services Canada currently pays for. It is negligence, and it is a disgrace.”
The Dene Nation suggested community dental visits are lacking because there is no incentive for dentists to bid on contracts to provide care.
“NIHB’s fees are lower than insured services, and many of the GNWT’s community facilities must be better equipped and maintained,” the Dene Nation’s press release asserted.
Antoine said he believes dentists are deterred from bidding on contracts by facilities that “badly need maintenance” and pay that isn’t matching what is available elsewhere, including Yellowknife.
“It would not be that way if equal service to all was the goal,” he stated.
The territorial government, in its own statement, expressed ” concern with the approach taken by Canada in the delivery of this program.”
Premier Caroline Cochrane and health minister Julie Green were in Ottawa last week discussing the need for increased federal support for the NIHB program, the territory stated, adding: “The GNWT is actively collaborating with Indigenous Services Canada to explore various options for the resumption of dental services in all regions.”
Contracts receive few, if any bids
The Dene Nation said requests for proposals (RFPs) for dental services were put out “at the last minute” before the previous contracts expired.
The GNWT put out RFPs in early February for dentists to provide care in the Beaufort Delta, Tłı̨chǫ, Sahtu, and Dehcho regions. The contracts closed on March 13, but only the Beaufort Delta and Dehcho contracts received bids.
Previous contracts with dentists were scheduled to expire on March 31, 2023, giving the GNWT a two-week window to award new contracts.
“While we don’t yet have new contracts in place, Indigenous Services Canada has recently given approval to continue with the same terms and providers as the previous contracts while the RFP process plays out, at which point we’d enter new contracts with the successful candidates,” the GNWT said.
The GNWT said no bids had been received for Sahtu and Tłı̨chǫ contracts.
“As this is still an active procurement for these services, we are limited on how we can respond,” the GNWT stated, though the deadline had not been extended on those RFPs as of June 28 and they did not appear to be “open” or “updated” on the GNWT’s contract opportunities website.
On the OpenNWT website, an independent portal that publishes territorial government procurement information, RFPs for regions that received one bid each are still listed as “closed” rather than “awarded.”
“There has been no communication from the GNWT about this,” Antoine was quoted as saying.